Peroneal sheath reconstruction (for peroneal tendon subluxation)
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The mechanism of injury that results in peroneal tendon subluxation is as for an ankle sprain, and a full assessment of the joint and stabilising ankle structures should be made, even in clear cases of peroneal subluxation.
However with subluxing peroneal tendons the chance of the resultant instability and secondary pain settling with conservative management is far less than with an ankle sprain. In other words once the tendons have subluxed this tends to continue, irrespective of conservative management. If presenting early though a short period of immobilisation to assist nature in
Most patients will demonstrate their subluxation without being asked but on occasion it can be subtle and require careful dynamic ultrasound assessment of the peroneal tendons during ankle circumduction.
There are certain anatomical variations that predispose to the condition, in particular a shallow fibular groove in which the tendons sit, as well as low-lying muscle bellies of peroneus longus or brevis, that will increase the bulk of tissue to be restrained by the peroneal retinaculum.
In longstanding cases attritional damage to the peroneal tendons can occur and is straightforwardly treated by intercurrent surgery to the tendons.
There are a few variations to the surgery required, ranging from simply reattaching the anterior edge of the retinaculum to the posterior aspect of the fibula, adding a bony burring of the peroneal groove in the posterior fibula to deepen it, to fractionally osteotomising the distal fibula and translating it posteriorly to prevent anterior subluxation of the tendons.
With appropriate surgery and rehabilitation post-operative recurrence is rare.
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Author: Mark Herron FRCS.
Institution: The Wellington Hospital, London, UK.
Clinicians should seek clarification on whether any implant demonstrated is licensed for use in their own country.
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